For many, if not most, men and women, a program of diet, exercise and stress control will bring cholesterol levels under control. But some of us need additional help.

The body makes its own cholesterol in the liver and, to a much lesser extent, in the intestine. But some of us make too much, and our bodies don’t dispose of it adequately once it’s made. Excess cholesterol builds up in the bloodstream and, well, you know the rest.

A number of substances can help lower cholesterol levels. Please see chapter 16 for a full discussion of your options regarding medications.

Partial Ileal Bypass. One of the most drastic measures to lower cholesterol levels remains experimental at the time of writing. Partial ileal bypass is a type of surgery of the intestine resulting in a shunting of food so that cholesterol cannot be absorbed by the body. This yields dramatic cholesterol reductions in the blood.

Over a ten-year period, 838 patients who had had a previous heart attack were divided into two groups at the University of Minnesota. One group received usual treatment and dietary recommendations; the other groups got the partial ileal bypass surgery. Researchers found that deaths due to heart disease were cut by 28 per cent in the surgery group. The surgery group experienced 34 per cent fewer heart attacks, and 63 per cent fewer coronary bypass operations and angioplasties.

In the intervening years, according to Dr Henry Buchwald, patients underwent angiograms to directly study their arteries. Each evaluation showed greater progression of the disease in the control group, while that with a greatly reduced cholesterol level demonstrated actual regression of heart disease.

Of course this is very serious intervention. First there is the consideration of such major surgery itself; all surgery comes with its share of complications. Second, there are serious drawbacks. Patients could eat only small meals and had to eat repeatedly throughout the day. Vitamin deficiencies occurred, requiring supplement injections. And many experienced gastrointestinal distress including diarrhoea. Much better to stick with far more pleasant ways to get and keep cholesterol levels down! However, the study does show the unequivocal benefits of cholesterol reduction.

LDL Pheresis. Here we have another experimental means of cholesterol reduction developed for those who have a genetically determined hyperproduction of cholesterol resulting in levels from 13 to 26. Such individuals may not be able to control their levels even with drugs and the strictest diet.

The technique calls for blood to be “washed” in a manner similar to kidney dialysis. Patients must go to a laboratory each week to undergo the three-hour-long process, which can cost thousands of dollars annually. It is a very special treatment for very special patients.

Vegetarianism. Some might smile that I would include vegetarianism along with other “big guns” of cholesterol count. However, not everyone is willing to completely eliminate all animal products and most fats and oils from the diet for the test of his or her life. But there’s no doubt this can be a very effective means of cholesterol control.

Most individuals will find that they can effectively control their cholesterol counts without giving up animal foods entirely. Carefully selected dairy foods, poultry and seafood are extremely low in fat and cholesterol. Moreover, some of the benefits ascribed to vegetarianism may be due more to what people do eat than to what they don’t. That is to say that the vegetarian diet, by definition, is high in whole-grain cereals, fruits, vegetables and dried beans and peas. A number of researchers who have investigated vegetarian diets have theorised that the nutrients in such foods may have a protective value over and above the lowering of dietary fat and cholesterol.

Dried beans and peas are rich sources of soluble fibre, known to directly lower cholesterol levels. Vegetarians rely on dried beans and peas as an excellent protein source in lieu of meat. Many fruits also provide significant amounts of soluble fibre.

And, as we’ll see in the next section of this chapter, certain nutrients including vitamins C and E and beta-carotene may offer protection against heart disease. Fruits and vegetables are the principal sources of those nutrients in the diet. I’ve discussed Dr Dean Ornish’s research with reversing heart disease. His approach, involving a low-fat, near-vegetarian diet, exercise and meditation, is spelled out in his book Dr. Dean Ornish’s Program for Reversing Heart Disease (Random House, 1990). The book contains a nice section on vegetarian cookery, with some of the recipes supplied by Chef Wolfgang Puck, of LA’s famous Spago restaurant. It’s a well thought-out book, and one you should consider adding to your heart-smart library.

If, like me, you prefer not to become a vegetarian, you still would be well advised to increase your daily intake of non-meat foods. A meatless meal once, twice or even three times a week is a good idea. On those days, concentrate on pastas, egg substitutes, fruits and vegetables, dried beans and peas and the low-fat and non-fat cheeses that have recently come on to the market.

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Cardio & Blood/ Cholesterol